A dressing or compress [1] is a piece of material such as a pad applied to a wound to promote healing and protect the wound from further harm. A dressing is designed to be in direct contact with the wound, as distinguished from a bandage, which is most often used to hold a dressing in place. Modern dressings are sterile.
A dressing can have a number of purposes, depending on the type, severity and position of the wound, although all purposes are focused on promoting recovery and protecting from further harm. Key purposes of a dressing are:
Ultimately, the aim of a dressing is to promote healing of the wound by providing a sterile, breathable and moist environment that facilitates granulation and epithelialization. This will then reduce the risk of infection, help the wound heal more quickly, and reduce scarring. [2]
Modern dressings [3] include dry or impregnated gauze, plastic films, gels, foams, hydrocolloids, hydrogels, and alginates. They provide different physical environments suited to different wounds:
Dressings can also regulate the chemical environment of a wound, usually with the aim of preventing infection by the impregnation of topical antiseptic chemicals. Commonly used antiseptics include povidone-iodine, boracic lint dressings or historically castor oil. [5] Antibiotics are also often used with dressings to prevent bacterial infection. Medical grade honey is another antiseptic option, and there is moderate evidence that honey dressings are more effective than common antiseptic and gauze for healing infected post-operative wounds. [6] Bioelectric dressings can be effective in attacking certain antibiotic-resistant bacteria [7] and speeding up the healing process. [8]
Dressings are also often impregnated with analgesics to reduce pain.
The physical features of a dressing can impact the efficacy of such topical medications. Occlusive dressings, made from substances impervious to moisture such as plastic or latex, can be used to increase their rate of absorption into the skin.
Dressings are usually secured with adhesive tape and/or a bandage. Many dressings today are produced as an "island" surrounded by an adhesive backing, ready for immediate application – these are known as island dressings.
Generally, these products are indicated for only superficial, clean, and dry wounds with minimal exudates. They can also be used as secondary dressings (additional dressings to secure the primary dressing in place or to absorb additional discharge from the wound). Examples are: Gauze, lint, adhesive bandage (plasters), and cotton wool. The main aim is to protect the wound from bacterial contamination. They are also used for secondary dressing. Gauze dressing is made up of woven or non-woven fibres of cotton, rayon, and polyester. Gauze dressing are capable of absorbing discharge from wound but requires frequent changing. Excessive wound discharge would cause the gauze to adhere to the wound, thus causes pain when trying to remove the gauze from the wound. Bandages are made up of cotton wool, cellulose, or polyamide materials. Cotton bandages can act as a secondary dressing while compression bandages provides good compressions for venous ulcers. On the other hand, tulle gras dressing which is impregnated with paraffin oil is indicated for superficial clean wound. [9]
Several types of interactive products are: semi-permeable film dressings, semi-permeable foam dressings, hydrogel dressings, hydrocolloid dressings, hydrofiber and alginate dressings. Apart from preventing bacteria contamination of the wound, they keep the wound environment moist in order to promote healing. [9]
Semi-permeable film dressing: This dressing is a transparent film made up of polyurethane. It allows the movement of water vapor, oxygen, and carbon dioxide into and out of the dressing. It also plays an additional role in autolytic debridement (removal of dead tissue) which is less painful when compared to manual wound debridement inside the operating theater. It is highly elastic and flexible, thus is closely adhered to the skin. As the dressing is transparent, wound inspection is possible without removing the dressing. Due to the limited absorption capacity, such dressing is only used in superficial wounds with low amount of discharge. [9]
Semi-permeable foam dressing: This dressing is made up of foam with hydrophilic (attracted to water) properties and outer layer of hydrophobic (repelled from water) properties with adhesive borders. The hydrophobic layer protects the wound from the outside fluid contamination. Meanwhile, the inner hydrophilic layer is able to absorb moderate amount of discharge from the wound. Therefore, this type of dressing is useful for wound with high amount of discharge and for wound with granulation tissue. Secondary dressings are not required. However, it requires frequent changing and is not suitable for dry wounds. Silicone is a common material that make up the foam. The foam is able to mold according to the shape of the wound. [9]
Hydrogel dressing: This dressing is made up of synthetic polymers such as methacrylate and polyvinyl pyrrolidine. It has high water content, thus provides moisture and cooling effect for the wound. The dressing is easy to remove from the wound without causing any damage. The dressing is also non-irritant. Therefore, it is used for dry necrotic wound, necrotic wound, pressure ulcers, and burn wound. It is not suitable for wounds with heavy discharge and infected wounds. [9]
Hydrocolloid dressing: This type of dressing contains two layers: inner colloidal layer and outer waterproof layer. It contains gel forming agents such as carboxymethylcellulose, gelatin and pectin. When the dressing is in contact with the wound, the wound discharge are retained to form gel which provides moist environment for wound healing. It protects the wound from bacterial contamination, absorbs wound discharge, and digests necrotic tissues. It is mostly use as secondary dressing. However, it is not used in wound with high discharge and neuropathic ulcers. [9]
Alginate dressing: This type of dressing is made up of either sodium or calcium salt of alginic acid. This dressing can absorb high amount of discharge from a wound. Ions present in the dressing can interact with blood to produce a film that protects the wound from bacterial contamination. However, this dressing is not suitable for dry wounds, third degree burn wound, and deep wounds with exposed bone. It also requires secondary dressing because wounds can quickly dry up with alginate dressing. [9]
Hydrofiber dressing: Made up of sodium carboxymethyl cellulose, hydrofibers can absorb high amounts of wound discharge, forming a gel and preventing skin maceration. [10]
Advancements in understanding of wounds have commanded biomedical innovations in the treatment of acute, chronic, and other types of wounds. Many biologics, skin substitutes, biomembranes and scaffolds have been developed to facilitate wound healing through various mechanisms. [11]
Applying a dressing is a first aid skill, although many people undertake the practice with no training – especially on minor wounds. Modern dressings will almost all come in a prepackaged sterile wrapping, date coded to ensure sterility. Sterility is necessary to prevent infection from pathogens resident within the dressing.
Historically, and still the case in many less developed areas and in an emergency, dressings are often improvised as needed. This can consist of anything, including clothing or spare material, which will fulfill some of the basic tenets of a dressing – usually stemming bleeding and absorbing exudate.
Applying and changing dressings is one common task of medical personnel.
A first aid kit or medical kit is a collection of supplies and equipment used to give immediate medical treatment, primarily to treat injuries and other mild or moderate medical conditions. There is a wide variation in the contents of first aid kits based on the knowledge and experience of those putting it together, the differing first aid requirements of the area where it may be used, and variations in legislation or regulation in a given area.
A wound is any disruption of or damage to living tissue, such as skin, mucous membranes, or organs. Wounds can either be the sudden result of direct trauma, or can develop slowly over time due to underlying disease processes such as diabetes mellitus, venous/arterial insufficiency, or immunologic disease. Wounds can vary greatly in their appearance depending on wound location, injury mechanism, depth of injury, timing of onset, and wound sterility, among other factors. Treatment strategies for wounds will vary based on the classification of the wound, therefore it is essential that wounds be thoroughly evaluated by a healthcare professional for proper management. In normal physiology, all wounds will undergo a series of steps collectively known as the wound healing process, which include hemostasis, inflammation, proliferation, and tissue remodeling. Age, tissue oxygenation, stress, underlying medical conditions, and certain medications are just a few of the many factors known to affect the rate of wound healing.
An adhesive bandage, also called a sticking plaster, medical plaster, or simply plaster in British English, is a small medical dressing used for injuries not serious enough to require a full-size bandage. They are also known by the genericized trademarks of Band-Aid or Elastoplast.
Povidone-iodine (PVP-I), also known as iodopovidone, is an antiseptic used for skin disinfection before and after surgery. It may be used both to disinfect the hands of healthcare providers and the skin of the person they are caring for. It may also be used for minor wounds. It may be applied to the skin as a liquid, an ointment or a powder.
Alginic acid, also called algin, is a naturally occurring, edible polysaccharide found in brown algae. It is hydrophilic and forms a viscous gum when hydrated. When the alginic acid binds with sodium and calcium ions, the resulting salts are known as alginates. Its colour ranges from white to yellowish-brown. It is sold in filamentous, granular, or powdered forms.
Moist desquamation is a description of the clinical pattern seen as a consequence of radiation exposure where the skin thins and then begins to weep because of loss of integrity of the epithelial barrier and decreased oncotic pressure. Moist desquamation is a rare complication for most forms of radiology, however it is far more common in fluoroscopy where threshold doses lie between 10-15 Gy and increasingly common above 15 Gy. It has been noted that fractionation of fluoroscopic procedures significantly reduces the likelihood of moist desquamation occurring. In animal studies done on pig skin, moist desquamation was found to occur with a 50% of the time after a single dose of 28 Gy, however a 2×18 Gy fractionation scheme was needed to produce the same 50% occurrence.
Venous ulcer is defined by the American Venous Forum as "a full-thickness defect of skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease, based on venous duplex ultrasound testing." Venous ulcers are wounds that are thought to occur due to improper functioning of venous valves, usually of the legs. They are an important cause of chronic wounds, affecting 1% of the population. Venous ulcers develop mostly along the medial distal leg, and can be painful with negative effects on quality of life.
Surgical tape or medical tape is a type of pressure-sensitive adhesive tape used in medicine and first aid to hold a bandage or other dressing onto a wound. These tapes usually have a hypoallergenic adhesive which is designed to hold firmly onto skin, dressing materials, and underlying layers of tape, but to remove easily without damaging the skin. They allow air to reach the skin ("breathable"). Some breathable tapes such as kinesiology tape, and other elastic bandages with adhesive are made of cotton. Surgical tape is often white because it contains zinc oxide, which is added to help prevent infections. Tapes made of porous material, such as 3M Micropore, are widely used.
Gauze is a thin, translucent fabric with a loose open weave. In technical terms, "gauze" is a weave structure in which the weft yarns are arranged in pairs and are crossed before and after each warp yarn, keeping the weft firmly in place. This weave structure is used to add stability to the fabric, which is important when using fine yarns loosely spaced. However, this weave structure can be used with any weight of yarn, and can be seen in some rustic textiles made from coarse hand-spun plant fiber yarns. Gauze is widely used for medical dressings.
The history of wound care spans from prehistory to modern medicine. Wounds naturally heal by themselves, but hunter-gatherers would have noticed several factors and certain herbal remedies would speed up or assist the process, especially if it was grievous. In ancient history, this was followed by the realisation of the necessity of hygiene and the halting of bleeding, where wound dressing techniques and surgery developed. Eventually the germ theory of disease also assisted in improving wound care.
Negative-pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC), is a therapeutic technique using a suction pump, tubing, and a dressing to remove excess exudate and promote healing in acute or chronic wounds and second- and third-degree burns. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment using a sealed wound dressing connected to a vacuum pump. The use of this technique in wound management started in the 1990s and this technique is often recommended for treatment of a range of wounds including dehisced surgical wounds, closed surgical wounds, open abdominal wounds, open fractures, pressure injuries or pressure ulcers, diabetic foot ulcers, venous insufficiency ulcers, some types of skin grafts, burns, sternal wounds. It may also be considered after a clean surgery in a person who is obese.
A hydrocolloid dressing is an opaque or transparent dressing for wounds. A hydrocolloid dressing is biodegradable, breathable, and depending on the dressing selected, may adhere to the skin, so no separate taping is needed.
An Unna’s boot is a special gauze bandage, which can be used for the treatment of venous stasis ulcers and other venous insufficiencies of the leg. It can also be used as a supportive bandage for sprains and strains of the foot, ankle and lower leg. The gauze is impregnated with a thick, creamy mixture of zinc oxide and calamine to promote healing. It may also contain acacia, glycerin, castor oil and white petrolatum.
Liquid bandage is a topical skin treatment for minor wounds which binds to the skin to form a protective polymeric layer that keeps dirt and germs out and moisture in. It can be directly applied to the wound after removing debris.
An alginate dressing is a natural wound dressing derived from carbohydrate sources released by clinical bacterial species, in the same manner as biofilm formation. These types of dressings are best used on wounds that have a large amount of exudate. They may be used on full-thickness burns, surgical wounds, split-thickness graft donor sites, Mohs surgery defects, refractory decubiti, and chronic ulcers. They can also be applied onto dry wounds after normal saline is first applied to the site of application.
Inadine is an iodine-containing non-sticky surgical dressing consisting of a knitted viscose fabric with a polyethylene glycol base that contains and slowly releases the antiseptic povidone-iodine (PVP-1). It is applied to superficial wounds.
Compeed is a brand of hydrocolloid gel plasters for treating blisters, corns, cracked heels and cold sores. It was originally developed by Lars Backsell while working in Denmark for Coloplast A/S. The brand was sold to Johnson & Johnson in May 2002, then acquired by HRA Pharma in 2017. Compeed plasters are still manufactured by Coloplast.
Postoperative wounds are those wounds acquired during surgical procedures. Postoperative wound healing occurs after surgery and normally follows distinct bodily reactions: the inflammatory response, the proliferation of cells and tissues that initiate healing, and the final remodeling. Postoperative wounds are different from other wounds in that they are anticipated and treatment is usually standardized depending on the type of surgery performed. Since the wounds are 'predicted' actions can be taken beforehand and after surgery that can reduce complications and promote healing.
Hydrogels are three-dimensional networks consisting of chemically or physically cross-linked hydrophilic polymers. The insoluble hydrophilic structures absorb polar wound exudates and allow oxygen diffusion at the wound bed to accelerate healing. Hydrogel dressings can be designed to prevent bacterial infection, retain moisture, promote optimum adhesion to tissues, and satisfy the basic requirements of biocompatibility. Hydrogel dressings can also be designed to respond to changes in the microenvironment at the wound bed. Hydrogel dressings should promote an appropriate microenvironment for angiogenesis, recruitment of fibroblasts, and cellular proliferation.
The periwound is tissue surrounding a wound. Periwound area is traditionally limited to 4 cm outside the wound's edge but can extend beyond this limit if outward damage to the skin is present. Periwound assessment is an important step of wound assessment before wound treatment is prescribed.
Major chemical drug groups – based upon the Anatomical Therapeutic Chemical Classification System | |
|---|---|
| gastrointestinal tract / metabolism (A) | |
| blood and blood forming organs (B) | |
| cardiovascular system (C) | |
| skin (D) | |
| genitourinary system (G) | |
| endocrine system (H) | |
| infections and infestations (J, P, QI) | |
| malignant disease (L01–L02) | |
| immune disease (L03–L04) | |
| muscles, bones, and joints (M) | |
| brain and nervous system (N) |
|
| respiratory system (R) | |
| sensory organs (S) | |
| other ATC (V) | |
